The Quarter Jack Surgery

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and said staff treated them with compassion and understanding. Representatives from the patient participation group (PPG) told us the provider took concerns seriously and made proactive improvements to the service. For example, people raised feedback that wait times on the telephone could be long. In response the service introduced a new telephony system which allows a call back function.

Managers encouraged staff to report incidents, near misses, and safety events, and these were discussed in team meetings where learning was identified and shared. Meeting minutes were available for staff who could not attend. Staff told us there was an open culture where safety was a top priority, and they felt confident to speak up when things went wrong or they had suggestions for improvement.

The provider had clear systems in place to record and investigate complaints and incidents. When things went wrong, staff apologised, offered support, and recorded their actions in line with duty of candour. Learning from incidents and complaints led to changes and improvements in the quality of care. For example, following an incident where vaccines were left unattended at reception and subsequently had to be disposed of, the service introduced a new sign-in system for vaccine deliveries. A designated fridge was installed in the reception area so vaccines could be stored safely if nursing staff were unavailable to collect and put them away immediately.

The service learned from significant events and demonstrated how lessons were applied in practice. As part of this, an ECG protocol was introduced to standardise the process for performing ECGs. This ensured that all ECGs were reviewed before the person left the building. The protocol was attached to all ECG machines and shared with all relevant staff members to reinforce compliance.

The service always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

There were systems in place for processing information relating to new people registering at the service. The service worked with other providers to deliver shared care and when people moved between services. Referrals and test results were seen to be managed in a timely way. Referrals to specialist services were made exclusively by GPs to ensure accuracy and appropriateness. For people with learning disabilities, adult access referrals were coordinated through signposting to relevant services.

The service regularly ran searches based on coded diagnoses to identify people with learning disabilities, tracking their care from childhood into adulthood. Annual health checks for people with learning disabilities were completed and documented in records. Reasonable adjustments required by people were clearly recorded on the home screen to ensure their needs were considered during referrals and routine care.

Nurses provided childhood immunisations and met quarterly with a health visitor to review vulnerable children and families. Meeting notes did not include identifiable information and instead, safeguarding concerns were appropriately coded and flagged with icons in peoples notes.

The service worked closely with the frailty team, who monitored safeguarding concerns and supported housebound people through regular assessments and ward rounds.

For children who did not attend (DNA) appointments, the service followed a clear process. For example, contacting parents or guardians to reschedule, informing the GP if contact was unsuccessful, and notifying the health visitor where safeguarding concerns existed. Opportunistic approaches were also used to encourage attendance.

To improve the uptake of childhood immunisations, the service offered flexible appointment times and took time to talk with parents about the benefits and safety of immunisations. Children’s immunisation clinics were held only at main site, where a GP would always be present and available. This ensured there was clinical oversight, immediate support if a child had a reaction, and guidance for nurses when complex medical or safeguarding concerns arose.

The service had developed their own in-house GP led frailty team including a nurse practitioner, GP registrar, health care assistant, and paramedic. A nurse from the ‘aging well team’ within the local primary care network (PCN) was also part of this team. This was in response to a high number of older and frail people. The team focussed on housebound and care home residents. People seen by the frailty team were coded within the clinical system received a ‘Dorset Care Plan’. This personalised care plan outlines a person’s health and social care needs, agreed goals, planned interventions, and the professionals responsible for each aspect of care, ensuring coordinated, person-centred support across multiple services.

The frailty team identified people requiring support were not always quickly recognised. To address this, they developed a triage system for care navigators using a red, amber, green (RAG) rating. Which was being introduced across the practice.

The frailty team worked closely with other organisations to ensure coordinated care across services. They collaborated with the integrated community learning team (ICLT), which provides access to community physiotherapists and occupational therapists from the local community NHS Trust. The team held monthly multidisciplinary team (MDT) meetings to discuss people receiving their services and to make referrals when required, such as for equipment or support in people’s own homes. Additionally, the frailty team shared email guides with local care homes on how to best use eConsult to submit patient information effectively and support timely triage.

The frailty team identified people living in local care homes, who relied on care workers to submit eConsult’s on their behalf, were not always providing sufficient information for timely triage. In response, the team now makes weekly, and sometimes daily, calls to care homes to discuss people and identify any concerns early. They visit care homes to provide upskilling sessions for care workers, enabling them to take and record observations. While care homes had the necessary equipment, staff had not previously received training. This initiative had improved care home staff’s ability to recognise infections and provide basic observations via eConsult, supporting timely clinical intervention.

The service had access to community district nurses based at the main site. The local district nursing team and the service reported this arrangement ensured consistent information-sharing and supported coordinated and responsive care. The district nurses confirmed they had timely access to a person’s named GPs when needed. The community district nurses also used the same clinical system as the service, allowing both teams to access the most up-to-date clinical information, including uploaded body maps. These body maps were used to monitor and record peoples skin integrity.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and well known to staff, who had received training appropriate to their roles. There was a designated safeguarding lead, and all staff were aware of who they were and how to escalate concerns. Clinical and non-clinical staff had chaperone responsibilities, and risk assessments had been completed for those who did not hold a disclosure and barring service (DBS) check, which ensured individuals were suitable to work with children and vulnerable adults. People were informed of the chaperone service available to them with posters displayed around the service.

Meetings were held with external organisations regarding vulnerable people, and while formal minutes were not always recorded, individual records were used to document relevant information and kept up to date. Regular safeguarding case reviews were completed, assessing the description of events, procedures followed, and outcomes to ensure policies were adhered to and all actions appropriately completed. These cases were discussed in scheduled safeguarding meetings, which were attended by relevant external organisations, such as health visitors, where appropriate, with meeting dates set in advance to allow consistent participation.

The service maintained a register of vulnerable people and acted promptly on concerns, working in partnership with other organisations. Safe systems and processes were in place to ensure children’s upcoming consultations were followed up if they failed to attend. People who had not attended were assessed on a case-by-case basis, with opportunities offered to engage and educate them. For example, if a parent repeatedly missed immunisation appointments for their child, the nursing team would invite them in to discuss the benefits and risks, supporting informed decision-making.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and well maintained. Staff were able to recognise when a person’s condition was deteriorating and knew what action to take. People were advised about the risks related to their condition and what to do if their condition worsened.

Regular audits were carried out to ensure coding was accurate and up to date. Systems were in place to share information with staff and other agencies, supporting the delivery of safe and effective care. The service monitored referral delays and had processes to track urgent cases. For example, audits were undertaken to ensure urgent cancer referrals were appropriately booked with secondary care providers. These referrals were used to investigate symptoms that may indicate cancer.

All people who used the service had a named GP and, where possible, were booked with their named clinician. Staff and people who used the service told us this supported continuity of care and helped build strong relationships between people using the service and their GP. If a person was unable to see their preferred GP, there were processes to ensure their named GP was informed of any appointments during their absence.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken, and identified risks were addressed. A business continuity plan was in place, monitored and reviewed.

Staff were observed removing their SMART cards when leaving their computers, ensuring devices were locked and access remained restricted. Fire extinguishers were in date and had received annual servicing, and clinical equipment was checked and calibrated to confirm it was safe for use. Portable appliance testing (PAT) had been completed; however, the most recent recorded date was 2017. In response, the service promptly arranged for PAT testing to be booked, and evidence of this action was seen. The premises were clean, well maintained, and free from obvious hazards.

At the service’s branch site, an asbestos report dated 2021 had previously confirmed the presence of asbestos which assessed the risk as low. The service acted promptly to ensure staff were informed of this risk and how to mitigate risks. The service’s fire wardens had been trained, and regular fire alarm tests, emergency lighting checks, and fire drills were taking place. However, no formal fire risk assessments had been completed since 2019 which is an annual requirement. The service responded quickly by arranging for a fire risk assessment and providing evidence of this. Support was also received from the local fire and rescue service in 2023 through a walkaround inspection, during which actions were recorded and completed. In response to this, one of services leaders was booked onto a health and safety course, run by the local medical committee, to improve the service’s compliance with legal requirements and best practice, scheduled for December 2025. Risk assessments covered wheelchairs used by the service, which were checked monthly.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles within the service. Staff training was up to date, learning needs were identified, and development was managed appropriately. Staff were working within their agreed areas of competence, and safe recruitment practices were followed.

The service regularly carried out retention reviews to understand why staff had left and to identify opportunities to improve recruitment. Leaders also reviewed staff rotas to compare planned versus actual staffing levels and to plan for adequate cover across departments and specific roles.

The service had recently responded to the Care Quality Commission (CQC) regarding concerns raised about staffing levels. They were able to demonstrate the actions taken in response, including analysis reviews, recruitment activity, and gathering staff feedback. Staff were aware of the service’s open-door policy, and wellbeing was embedded within supervision and appraisal processes.

During this assessment, staff feedback was positive. Staff told us leaders were supportive and approachable. The service had updated its recruitment policy to ensure Disclosure and Barring Service (DBS) checks were received before new staff members started employment. Where appropriate, referrals were made to occupational health to support staff. This was in response to previous assurances requested from the Care Quality Commission (CQC), where staff retention data was analysed.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The service had a designated infection prevention and control (IPC) lead, and all staff had completed relevant training. Cleaning schedules were in place and followed, with risk assessments and audits completed and actions taken to mitigate identified risks. Bodily fluid spillage kits were available and accessible to staff, supporting the safe management of potential contamination incidents.

The service had appropriate arrangements for the segregation and disposal of clinical waste. Cleaning cupboards were checked, and all cleaning materials had appropriate processes in place to control substances hazardous to health. Cleaning materials used by the external cleaning provider were stored in a designated cupboard, which was well organised and correctly documented.

The service was observed to be clean and tidy during our onsite visit to the main site. However, at the branch site, there was carpet in some accessible areas where cleaning risk assessments had not been completed. Staff were able to describe how they managed bodily fluid spillages in these areas until the external cleaning provider could carry out a deep clean, and affected areas were cordoned off to prevent access until cleaning was completed. Additionally, while the cleaning cupboard was well organised and documented at the branch site, there was no signage displayed on the outside of the cupboard to confirm its contents. In response, the service advised appropriate signage would be placed.

Whilst the IPC lead ensured all nursing staff had received hand hygiene audits; these had not yet been completed for the GPs, the service had plans to schedule these as soon as possible.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or if they experienced any unexpected symptoms.

Staff received regular training, were competency assessed in medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Prescription stationery was managed securely, and protocols were followed to ensure medicines were prescribed safely. There was a weekly audit process to monitor non-medical prescribers’ competencies and ensure they worked within their scope of practice.

Remote clinical searches conducted as part of this assessment demonstrated positive outcomes in relation to long-term conditions, disease-modifying antirheumatic drugs (DMARDs), missed diagnoses and medicine reviews, showing compliance with national guidance. For example, out of the 2,088 people on the asthma register, 71 people had been prescribed 2 or more courses of rescue steroids in the last 12 months. We reviewed 5 of these records and saw that they had all received appropriate monitoring and referrals when required.

For chronic kidney disease (CKD), out of the 1,234 people with stages 4 or 5. Nine people were identified as not having the required blood test monitoring. We reviewed 5 of these 9 records and found all 5 had received the correct blood test monitoring, some of which had been completed in another hospital department, and the dates simply required updating on the service’s clinical system.

For diabetes, out of 989 people, 120 people were identified requiring follow-up blood test monitoring. We reviewed 5 of these records and found they all had an up-to-date HbA1c test result, which is used to assess average blood sugar control over time. This search showed people had been effectively monitored and reviewed, and the required annual reviews had also been conducted or booked in.

We also reviewed people who may have a potential missed diagnosis of diabetes. Of those, 19 records were identified, and we reviewed 5 of these in more detail. One person needed a repeat blood test, which was already planned; 1 required coding as pre-diabetic and 1 was confirmed as diabetic but only recently and required coding. The remaining 2 did not indicate any issue with monitoring.

For DMARDs, out of 118 people prescribed medicines such as Methotrexate, 3 people were overdue for blood test monitoring. We reviewed 2 of these records and found 1 was monitored regularly by the hospital and the other had an appointment already booked.

For Leflunomide, 8 people were identified, and 4 required blood test monitoring within the last 6 months. We checked all 4 records and confirmed that all had received appropriate monitoring and were not overdue.

For warfarin, out of 47 people prescribed this medicine, 9 were identified as not having received required monitoring. We checked 5 of these records and found 3 people had been contacted to book their routine monitoring, and the other 2 showed evidence of appropriate monitoring taking place. There was also a safety-netting process in place where people inform their anticoagulant clinics of blood results within 7 days of these being due. The anticoagulant clinic writes to both the service and the person. At the time of the clinical searches, there was no policy in relation to warfarin monitoring to make this process clear to all staff Leaders confirmed this would now be included.

We reviewed compliance with Medicines and Healthcare products Regulatory Agency (MHRA) alerts. The specific alert reviewed related to the use of aldosterone antagonists with ACE inhibitors or ARBs where no urea and electrolyte (UE) monitoring had been recorded in the previous 6 months. These medicines are often used together to treat conditions such as heart failure, but they can increase the risk of high potassium levels and kidney problems if not monitored with regular blood tests. No people were found to be overdue blood tests by more than 2 months, and those identified had already been contacted to book appointments.

A sample of records was reviewed to identify if people had received appropriate medication reviews within the last 3 months. The review identified GPs had been completing comprehensive reviews for 3 of the records, and the other 3 had been completed by the appropriate nurse or senior leader focused on a particular medicine.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were stored safely and subject to the required safety risk assessments. Medicines requiring refrigeration were stored and monitored appropriately. Staff checked and recorded fridge temperatures daily to ensure they remained within the required range. The service used a data logger to identify any temperature fluctuations and support decision-making in line with the cold chain protocol. The service had invested in a smart monitoring app linked to the fridges, which alerted staff if the temperature moved out of range or if power was lost. This enabled leaders to respond quickly to any temperature breaches and take immediate corrective action to maintain medicine safety.

The service had effective systems in place to manage and respond to safety alerts and medicines recalls. Staff followed established processes to ensure that people prescribed medicines with specific risks received appropriate monitoring. Staff took steps to ensure medicines were prescribed appropriately to optimise care outcomes, including antibiotic stewardship. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was lower than local and national averages. There was a programme of regular clinical audits focusing on prescribing to improve care and treatment.

All Patient Group Directions (PGDs) and Patient Specific Directions (PSDs) were up to date, regularly reviewed and kept current to ensure people received the correct treatment as planned. PGDs are written instructions that allow healthcare professionals to supply or administer certain medicines to groups of patients without a prescription. PSDs are written instructions for an individual person, tailored to their specific health needs.